Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende
Erweiterte Suche
Anmelden
nach oben
Current Neurology and Neuroscience Reports
Erschienen in: Current Neurology and Neuroscience Reports 2/2017

01.02.2017 | Neurology of Systemic Diseases (J Biller, Section Editor)

Stroke Chameleons and Stroke Mimics in the Emergency Department

verfasst von: Ava L. Liberman, Shyam Prabhakaran

Erschienen in: Current Neurology and Neuroscience Reports | Ausgabe 2/2017

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

We discuss the frequency of stroke misdiagnosis in the emergency department (ED), identify common diagnostic pitfalls, describe strategies to reduce diagnostic error, and detail ongoing research.

Recent Findings

The National Academy of Medicine has re-defined and highlighted the importance of diagnostic errors for patient safety. Recent rates of stroke under-diagnosis (false-negative cases, “stroke chameleons”) range from 2–26% and 30–43% for stroke over-diagnosis (false-positive cases, “stroke mimics”). Failure to diagnosis stroke can preclude time-sensitive treatments and has been associated with poor outcomes. Strategies have been developed to improve detection of posterior circulation stroke syndromes, but ongoing work is needed to reduce under-diagnosis in other atypical stroke presentations. The published rates of harm associated with stroke over-diagnosis, particularly thrombolysis of stroke mimics, remain low.

Summary

Additional strategies to improve the accuracy of stroke diagnosis should focus on rapid clinical reasoning in the time-sensitive setting of acute ischemic stroke and identifying imperfections in the healthcare system which may contribute to diagnostic error.
Literatur
1.
2.
•• Balogh EP, Miller BT, and Ball JR, editors. National Academies of Sciences E, and Medicine. Improving Diagnosis in Healthcare. Washington, DC: The National Academies Press; 2015. Consensus report detailing what is known about diagnostic error in medicine, establishing methods to improve diagnostic safety in healthcare, and suggesting new research directions in the field.
3.
Schiff GD, Hasan O, Kim S, Abrams R, Cosby K, Lambert BL, et al. Diagnostic error in medicine: analysis of 583 physician-reported errors. Arch Intern Med. 2009;169(20):1881–7.PubMedCrossRef
4.
Graber ML, Franklin N, Gordon R. Diagnostic error in internal medicine. Arch Intern Med. 2005;165(13):1493–9.PubMedCrossRef
5.
Graber M, Gordon R, Franklin N. Reducing diagnostic errors in medicine: what’s the goal? Acad Med. 2002;77(10):981–92.PubMedCrossRef
6.
Newman-Toker DE, Pronovost PJ. Diagnostic errors--the next frontier for patient safety. JAMA. 2009;301(10):1060–2.PubMedCrossRef
7.
Newman-Toker DE, Perry JJ. Acute diagnostic neurology: challenges and opportunities. Acad Emerg Med. 2015;22(3):357–61.PubMedCrossRef
8.
• Richoz B, Hugli O, Dami F, Carron PN, Faouzi M, Michel P. Acute stroke chameleons in a university hospital: Risk factors, circumstances, and outcomes. Neurology. 2015;85(6):505–11. Using a prospective stroke registry, Richoz B Et al. found that forty-seven of 2,200 ischemic stroke patients were missed (2.1%). Compared to accurately diagnosed stroke patients, stroke chameleons presented more often with milder strokes or coma, fewer focal signs and cerebellar strokes, and had higher disability and mortality rates at 12 months.PubMedCrossRef
9.
• Arch AE, Weisman DC, Coca S, Nystrom KV, Wira 3rd CR, Schindler JL. Missed Ischemic Stroke Diagnosis in the Emergency Department by Emergency Medicine and Neurology Services. Stroke. 2016;47(3):668–73. Retrospective chart review of 465 ischemic stroke patients at an academic center and a large community hospital; 22% of patients were initially missed at the combined centers. Atypical symptoms associated with posterior circulation strokes lead to misdiagnoses at both centers.PubMed
10.
Newman-Toker DE, McDonald KM, Meltzer DO. How much diagnostic safety can we afford, and how should we decide? A health economics perspective. BMJ Qual Saf. 2013;22 Suppl 2:ii11–20.PubMedPubMedCentralCrossRef
11.
12.
13.
Kim AS, Moffatt E, Ursell PC, Devinsky O, Olgin J, Tseng ZH. Sudden neurologic death masquerading as out-of-hospital sudden cardiac death. Neurology. 2016;87(16):1669–73.PubMedCrossRef
14.
•• Madsen TE, Khoury J, Cadena R, Adeoye O, Alwell KA, Moomaw CJ, et al. Potentially Missed Diagnosis of Ischemic Stroke in the Emergency Department in the Greater Cincinnati/Northern Kentucky Stroke Study. Acad Emerg Med. 2016;23(10):1128–35. A large retrospective population based study of stroke patients where a total of 14% of patients were initially missed in the ED.PubMedCrossRef
15.
•• Newman-Toker DE, Moy E, Valente E, Coffey R, Hines A. Missed diagnosis of stroke in the emergency department: a cross-sectional analysis of a large population-based sample. Diagnosis. 2014;1(2):155–66. Using administrative data, the authors found that 12.7% of stroke patients were seen and discharged from an ED in the 30 days prior to their stroke admission for symptoms suggestive of a missed stroke.CrossRef
16.
Lever NM, Nystrom KV, Schindler JL, Halliday J, Wira 3rd C, Funk M. Missed opportunities for recognition of ischemic stroke in the emergency department. J Emerg Nurs. 2013;39(5):434–9.PubMedCrossRef
17.
Dupre CM, Libman R, Dupre SI, Katz JM, Rybinnik I, Kwiatkowski T. Stroke chameleons. J Stroke Cerebrovasc Dis. 2014;23(2):374–8.PubMedCrossRef
18.
Brandler ES, Sharma M, Sinert RH, Levine SR. Prehospital stroke scales in urban environments: a systematic review. Neurology. 2014;82(24):2241–9.PubMedPubMedCentralCrossRef
19.
Posner JS, Saper CB, Schiff ND, Plum F. Plum and Posner’s Diagnosis of Stupor and Coma. New York: Oxford University Press; 2007.
20.
Newman-Toker DE. Missed stroke in acute vertigo and dizziness: It is time for action, not debate. Ann Neurol. 2016;79(1):27–31.PubMedCrossRef
21.
Newman-Toker DE, Cannon LM, Stofferahn ME, Rothman RE, Hsieh YH, Zee DS. Imprecision in patient reports of dizziness symptom quality: a cross-sectional study conducted in an acute care setting. Mayo Clin Proc. 2007;82(11):1329–40.PubMedCrossRef
22.
• Edlow JA, Newman-Toker D. Using the Physical Examination to Diagnose Patients with Acute Dizziness and Vertigo. J Emerg Med. 2016;50(4):617–28. Review article designed to help Emergency Medicine physicians accurately discriminate between benign inner ear conditions and dangerous central causes of dizzness/vertigo. The article includes a discussion of pearls in the history taking and physical examination of dizzy patients, a frequent complaint in stroke chameleons.PubMedCrossRef
23.
Newman-Toker DE, Edlow JA. TiTrATE: A Novel, Evidence-Based Approach to Diagnosing Acute Dizziness and Vertigo. Neurol Clin. 2015;33(3):577–99. viii.PubMedPubMedCentralCrossRef
24.
Vermeulen MJ, Schull MJ. Missed diagnosis of subarachnoid hemorrhage in the emergency department. Stroke. 2007;38(4):1216–21.PubMedCrossRef
25.
26.
Pollak L, Shlomo N, Korn Lubetzki I, National Acute Stroke Israeli Survey G. Headache in stroke according to National Acute Stroke Israeli Survey. Acta Neurol Scand. 2016.
27.
Tentschert S, Wimmer R, Greisenegger S, Lang W, Lalouschek W. Headache at stroke onset in 2196 patients with ischemic stroke or transient ischemic attack. Stroke. 2005;36(2):e1–3.PubMedCrossRef
28.
Verdelho A, Ferro JM, Melo T, Canhao P, Falcao F. Headache in acute stroke. A prospective study in the first 8 days. Cephalalgia. 2008;28(4):346–54.PubMedCrossRef
29.
Vestergaard K, Andersen G, Nielsen MI, Jensen TS. Headache in stroke. Stroke. 1993;24(11):1621–4.PubMedCrossRef
30.
Kurth T, Diener HC. Migraine and stroke: perspectives for stroke physicians. Stroke. 2012;43(12):3421–6.PubMedCrossRef
31.
Long B, Koyfman A. Clinical Mimics: An Emergency Medicine-Focused Review of Stroke Mimics. J Emerg Med. 2016.
32.
Lopez JI, Holdridge A, Rothrock JF. Hemiplegia and headache: a review of hemiplegia in headache disorders. Curr Pain Headache Rep. 2015;19(2):471.PubMedCrossRef
33.
Oygarden H, Elnan Kvistad C, Thomassen L, Waje-Andreassen U, Naess H. Does a history of migraine affect the rate of thrombolysis in young stroke patients? Stroke Res Treat. 2013;2013:351064.PubMedPubMedCentral
34.
Nye BL, Ward TN. Clinic and emergency room evaluation and testing of headache. Headache. 2015;55(9):1301–8.PubMedCrossRef
35.
Perry JJ, Stiell IG, Sivilotti ML, Bullard MJ, Hohl CM, Sutherland J, et al. Clinical decision rules to rule out subarachnoid hemorrhage for acute headache. JAMA. 2013;310(12):1248–55.PubMedCrossRef
36.
Burch RC, Loder S, Loder E, Smitherman TA. The prevalence and burden of migraine and severe headache in the United States: updated statistics from government health surveillance studies. Headache. 2015;55(1):21–34.PubMedCrossRef
37.
38.
Martin-Schild S, Albright KC, Tanksley J, Pandav V, Jones EB, Grotta JC, et al. Zero on the NIHSS does not equal the absence of stroke. Ann Emerg Med. 2011;57(1):42–5.PubMedCrossRef
39.
Lee H, Sohn SI, Cho YW, Lee SR, Ahn BH, Park BR, et al. Cerebellar infarction presenting isolated vertigo: frequency and vascular topographical patterns. Neurology. 2006;67(7):1178–83.PubMedCrossRef
40.
Kamel H, Dhaliwal G, Navi BB, Pease AR, Shah M, Dhand A, et al. A randomized trial of hypothesis-driven vs screening neurologic examination. Neurology. 2011;77(14):1395–400.PubMedPubMedCentralCrossRef
41.
Savitz SI, Caplan LR, Edlow JA. Pitfalls in the diagnosis of cerebellar infarction. Acad Emerg Med. 2007;14(1):63–8.PubMedCrossRef
42.
Kerber KA, Morgenstern LB, Meurer WJ, McLaughlin T, Hall PA, Forman J, et al. Nystagmus assessments documented by emergency physicians in acute dizziness presentations: a target for decision support? Acad Emerg Med. 2011;18(6):619–26.PubMedPubMedCentralCrossRef
43.
Bowen JL. Educational strategies to promote clinical diagnostic reasoning. N Engl J Med. 2006;355(21):2217–25.PubMedCrossRef
44.
Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke. 2009;40(11):3504–10.PubMedPubMedCentralCrossRef
45.
Kerber KA, Meurer WJ, Brown DL, Burke JF, Hofer TP, Tsodikov A, et al. Stroke risk stratification in acute dizziness presentations: A prospective imaging-based study. Neurology. 2015;85(21):1869–78.PubMedPubMedCentralCrossRef
46.
Navi BB, Kamel H, Shah MP, Grossman AW, Wong C, Poisson SN, et al. Application of the ABCD2 score to identify cerebrovascular causes of dizziness in the emergency department. Stroke. 2012;43(6):1484–9.PubMedCrossRef
47.
48.
Newman-Toker DE, Curthoys IS, Halmagyi GM. Diagnosing Stroke in Acute Vertigo: The HINTS Family of Eye Movement Tests and the Future of the “Eye ECG”. Semin Neurol. 2015;35(5):506–21.PubMedCrossRef
49.
50.
Makin SD, Doubal FN, Dennis MS, Wardlaw JM. Clinically Confirmed Stroke With Negative Diffusion-Weighted Imaging Magnetic Resonance Imaging: Longitudinal Study of Clinical Outcomes, Stroke Recurrence, and Systematic Review. Stroke. 2015;46(11):3142–8.PubMedPubMedCentralCrossRef
51.
Chalela JA, Kidwell CS, Nentwich LM, Luby M, Butman JA, Demchuk AM, et al. Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Lancet. 2007;369(9558):293–8.PubMedPubMedCentralCrossRef
52.
Grewal K, Austin PC, Kapral MK, Lu H, Atzema CL. Missed strokes using computed tomography imaging in patients with vertigo: population-based cohort study. Stroke. 2015;46(1):108–13.PubMedCrossRef
53.
Kerber KA, Burke JF, Brown DL, Meurer WJ, Smith MA, Lisabeth LD, et al. Does intracerebral haemorrhage mimic benign dizziness presentations? A population based study. Emerg Med J. 2012;29(1):43–6.PubMedCrossRef
54.
Singh H, Graber ML, Hofer TP. Measures to improve diagnostic safety in clinical practice. J Patient Saf. 2016.
55.
Schiff GD. Minimizing diagnostic error: the importance of follow-up and feedback. Am J Med. 2008;121(5 Suppl):S38–42.PubMedCrossRef
56.
• Goyal MS, Hoff BG, Williams J, Khoury N, Wiesehan R, Heitsch L, et al. Streamlined Hyperacute Magnetic Resonance Imaging Protocol Identifies Tissue-Type Plasminogen Activator-Eligible Stroke Patients When Clinical Impression Is Stroke Mimic. Stroke. 2016;47(4):1012–7. A single academic center reports on their implimentation of a streamlined hyperacute MRI protocol for use when a stroke mimic diagnosis was favored and tPA was being withheld by the evaluating neurologist. A total of 7 out of 106 (6.6%) of IV tPA treated patients underwent an MRI to aid in decision making once the protocol was established.PubMedCrossRef
57.
Shah S, Luby M, Poole K, Morella T, Keller E, Benson RT, et al. Screening with MRI for Accurate and Rapid Stroke Treatment: SMART. Neurology. 2015;84(24):2438–44.PubMedPubMedCentralCrossRef
58.
Mohamed W, Bhattacharya P, Chaturvedi S. Early access to a neurologist reduces the rate of missed diagnosis in young strokes. J Stroke Cerebrovasc Dis. 2013;22(8):e332–7.PubMedCrossRef
59.
Croskerry P. The importance of cognitive errors in diagnosis and strategies to minimize them. Acad Med. 2003;78(8):775–80.PubMedCrossRef
60.
Meyer AN, Payne VL, Meeks DW, Rao R, Singh H. Physicians’ diagnostic accuracy, confidence, and resource requests: a vignette study. JAMA Intern Med. 2013;173(21):1952–8.
61.
Merino JG, Luby M, Benson RT, Davis LA, Hsia AW, Latour LL, et al. Predictors of acute stroke mimics in 8187 patients referred to a stroke service. J Stroke Cerebrovasc Dis. 2013;22(8):e397–403.PubMedCrossRef
62.
El Husseini N, Goldstein LB. “Code stroke”: hospitalized versus emergency department patients. J Stroke Cerebrovasc Dis. 2013;22(4):345–8.PubMedCrossRef
63.
Gioia LC, Zewude RT, Kate MP, Liss K, Rowe BH, Buck B, et al. Prehospital systolic blood pressure is higher in acute stroke compared with stroke mimics. Neurology. 2016;86(23):2146–53.PubMedCrossRef
64.
Guerrero WR, Savitz SI. Tissue-type plasminogen activator for stroke mimics: continuing to be swift rather than delaying treatment to be sure. Stroke. 2013;44(5):1213–4.PubMedPubMedCentralCrossRef
65.
Martinez-Ramirez S, Delgado-Mederos R, Marti-Vilalta JL, Marti-Fabregas J. Safety of tPA in stroke mimics and neuroimaging-negative cerebral ischemia: swift or sure? The acceptable rate of neurovascular mimics among IV tPA-treated patients. Neurology. 2010;75(20):1853. author reply 4.PubMedCrossRef
66.
Spokoyny I, Raman R, Ernstrom K, Meyer BC, Hemmen TM. Imaging negative stroke: diagnoses and outcomes in intravenous tissue plasminogen activator-treated patients. J Stroke Cerebrovasc Dis. 2014;23(5):1046–50.PubMedCrossRef
67.
Zinkstok SM, Engelter ST, Gensicke H, Lyrer PA, Ringleb PA, Artto V, et al. Safety of thrombolysis in stroke mimics: results from a multicenter cohort study. Stroke. 2013;44(4):1080–4.PubMedCrossRef
68.
• Tsivgoulis G, Zand R, Katsanos AH, Goyal N, Uchino K, Chang J, et al. Safety of intravenous thrombolysis in stroke mimics: prospective 5-year study and comprehensive meta-analysis. Stroke. 2015;46(5):1281–7. Meta-analysis of 9 studies demonstrating that the pooled rates of symptomatic intracerebral hemorrhage among 392 stroke mimics treated with IV tPA were 0.5% (95% confidence interval, 0%–2%); significantly lower risk than patients with acute ischemic stroke (risk ratio = 0.33; 95% confidence interval, 0.14–0.77; P = 0.010). No evidence of heterogeneity or publication bias was detected.PubMedCrossRef
69.
Demaerschalk BM, Kleindorfer DO, Adeoye OM, Demchuk AM, Fugate JE, Grotta JC, et al. Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2016;47(2):581–641.PubMedCrossRef
70.
Libman RB, Wirkowski E, Alvir J, Rao TH. Conditions that mimic stroke in the emergency department. Implications for acute stroke trials. Arch Neurol. 1995;52(11):1119–22.PubMedCrossRef
71.
Gargalas S, Weeks R, Khan-Bourne N, Shotbolt P, Simblett S, Ashraf L et al. Incidence and outcome of functional stroke mimics admitted to a hyperacute stroke unit. J Neurol Neurosurg Psychiatry. 2017 Jan;88(1):2–6.
72.
73.
Kim JT, Fonarow GC, Smith EE, Reeves MJ, Navalkele DD, Grotta JC et al. Treatment with TPA in the “Golden Hour” and the Shape of the 4.5 Hour Time-Benefit Curve in the National US Get With The Guidelines-Stroke Population. Circulation. 2017 Jan 10;135(2):128–139.
74.
Goyal N, Male S, Al Wafai A, Bellamkonda S, Zand R. Cost burden of stroke mimics and transient ischemic attack after intravenous tissue plasminogen activator treatment. J Stroke Cerebrovasc Dis. 2015;24(4):828–33.PubMedCrossRef
75.
Liberman AL, Liotta EM, Caprio FZ, Ruff I, Maas MB, Bernstein RA, et al. Do efforts to decrease door-to-needle time risk increasing stroke mimic treatment rates? Neurol Clin Pract. 2015;5(3):247–52.PubMedPubMedCentralCrossRef
76.
Ford AL, Williams JA, Spencer M, McCammon C, Khoury N, Sampson TR, et al. Reducing door-to-needle times using Toyota’s lean manufacturing principles and value stream analysis. Stroke. 2012;43(12):3395–8.PubMedPubMedCentralCrossRef
77.
Meretoja A, Weir L, Ugalde M, Yassi N, Yan B, Hand P, et al. Helsinki model cut stroke thrombolysis delays to 25 minutes in Melbourne in only 4 months. Neurology. 2013;81(12):1071–6.PubMedCrossRef
78.
Ben-Yakov M, Kapral MK, Fang J, Li S, Vermeulen MJ, Schull MJ. The Association Between Emergency Department Crowding and the Disposition of Patients With Transient Ischemic Attack or Minor Stroke. Acad Emerg Med. 2015;22(10):1145–54.PubMedCrossRef
79.
Hand PJ, Kwan J, Lindley RI, Dennis MS, Wardlaw JM. Distinguishing between stroke and mimic at the bedside: the brain attack study. Stroke. 2006;37(3):769–75.PubMedCrossRef
80.
Forster A, Griebe M, Wolf ME, Szabo K, Hennerici MG, Kern R. How to identify stroke mimics in patients eligible for intravenous thrombolysis? J Neurol. 2012;259(7):1347–53.PubMedCrossRef
81.
Sylaja PN, Dzialowski I, Krol A, Roy J, Federico P, Demchuk AM, et al. Role of CT angiography in thrombolysis decision-making for patients with presumed seizure at stroke onset. Stroke. 2006;37(3):915–7.PubMedCrossRef
82.
Ghika-Schmid F, Ghika J, Regli F, Bogousslavsky J. Hyperkinetic movement disorders during and after acute stroke: the Lausanne Stroke Registry. J Neurol Sci. 1997;146(2):109–16.PubMedCrossRef
83.
Wilson LK, Benavente OR, Woolfenden AR, Asdaghi N. Spontaneous limb movements and posturing secondary to acute basilar artery occlusion: a potentially devastating seizure mimic. Pract Neurol. 2014;14(1):42–4.PubMedCrossRef
84.
Conte WL, Gill CE, Biller J. Top of the basilar syndrome presenting with convulsions. JAMA Neurol. 2016.
85.
Alonso JV, del Pozo FJ, Simon JC, Valenzuela S, Perez Gomez F, Lopera E. Limb-Shaking TIA Presenting as Hemichorea-Hemiballismus: TIA Chameleons Diagnostic Challenge in the Emergency Department. J Stroke Cerebrovasc Dis. 2015;24(11):e327–31.PubMedCrossRef
86.
Rostanski SK, Williams O, Stillman JI, Marshall RS, Willey JZ. Language barriers between physicians and patients are not associated with thrombolysis of stroke mimics. Neurol Clin Pract. 2016;6(5):389–96.PubMedCrossRef
87.
Kidwell CS, Starkman S, Eckstein M, Weems K, Saver JL. Identifying stroke in the field. Prospective validation of the Los Angeles prehospital stroke screen (LAPSS). Stroke. 2000;31(1):71–6.PubMedCrossRef
88.
Nor AM, Davis J, Sen B, Shipsey D, Louw SJ, Dyker AG, et al. The Recognition of Stroke in the Emergency Room (ROSIER) scale: development and validation of a stroke recognition instrument. Lancet Neurol. 2005;4(11):727–34.PubMedCrossRef
89.
•• Goyal N, Tsivgoulis G, Male S, Metter EJ, Iftikhar S, Kerro A, et al. FABS: An Intuitive Tool for Screening of Stroke Mimics in the Emergency Department. Stroke. 2016;47(9):2216–20. A scoring system to aide in acute ischemic stroke diagnosis, FABS, was validated in 784 patients (41% stroke mimics). Receiver operating characteristic curve (C statistic of 0.95) indicated that FABS ≥ 3 points could identify stroke mimics with 90% sensitivity and 91% specificity.
90.
• Ali SF, Viswanathan A, Singhal AB, Rost NS, Forducey PG, Davis LW, et al. The TeleStroke mimic (TM)-score: a prediction rule for identifying stroke mimics evaluated in a Telestroke Network. J Am Heart Assoc. 2014;3(3):e000838. The authors develop a prediction rule to prospectively identify stroke mimics during telestroke evaluation of possible ischemic stroke. When the rule was applied to an internal validation cohort the area under the curve was 0.77 +/− 0.03 and .77 +/− 0.03 in the external validation cohort.
91.
Wendt M, Ebinger M, Kunz A, Rozanski M, Waldschmidt C, Weber JE, et al. Copeptin Levels in Patients With Acute Ischemic Stroke and Stroke Mimics. Stroke. 2015;46(9):2426–31.PubMedCrossRef
92.
93.
Kim DH, Saver JL, Starkman S, Liebeskind DS, Ali LK, Restrepo L, et al. Enrollment Yield and Reasons for Screen Failure in a Large Prehospital Stroke Trial. Stroke. 2016;47(1):232–5.PubMedCrossRef
94.
Zappella N, Merceron S, Nifle C, Hilly-Ginoux J, Bruneel F, Troche G, et al. Artery of Percheron infarction as an unusual cause of coma: three cases and literature review. Neurocrit Care. 2014;20(3):494–501.PubMedCrossRef
95.
Blumenfeld H. Neuroanatomy through Clinical Cases. New York: Sinauer Associates, Inc; 2010.
96.
Botez SA, Carrera E, Maeder P, Bogousslavsky J. Aggressive behavior and posterior cerebral artery stroke. Arch Neurol. 2007;64(7):1029–33.PubMedCrossRef
97.
Mesulam MM, Waxman SG, Geschwind N, Sabin TD. Acute confusional states with right middle cerebral artery infarctions. J Neurol Neurosurg Psychiatry. 1976;39(1):84–9.PubMedPubMedCentralCrossRef
98.
Sambunaris A, Hyde TM. Stroke-related aphasias mistaken for psychotic speech: two case reports. J Geriatr Psychiatry Neurol. 1994;7(3):144–7.PubMedCrossRef
Metadaten
Titel
Stroke Chameleons and Stroke Mimics in the Emergency Department
verfasst von
Ava L. Liberman
Shyam Prabhakaran
Publikationsdatum
01.02.2017
Verlag
Springer US
Erschienen in
Current Neurology and Neuroscience Reports / Ausgabe 2/2017
Print ISSN: 1528-4042
Elektronische ISSN: 1534-6293
DOI
https://doi.org/10.1007/s11910-017-0727-0

Weitere Artikel der Ausgabe 2/2017

Current Neurology and Neuroscience Reports 2/2017 Zur Ausgabe

Pediatric Neurology (WE Kaufmann, Section Editor)

Epileptic Encephalopathies—Clinical Syndromes and Pathophysiological Concepts

Neurology of Systemic Diseases (J Biller, Section Editor)

Neurological Complications of the Leukemias Across the Ages

Neurology of Systemic Diseases (J Biller, Section Editor)

Systemic Complications of Spinal Cord Injury

Pediatric Neurology (WE Kaufmann, Section Editor)

Transcranial Magnetic and Direct Current Stimulation in Children

Dementia (KS Marder, Section Editor)

Statistical Approaches to Longitudinal Data Analysis in Neurodegenerative Diseases: Huntington’s Disease as a Model

Movement Disorders (SH Fox, Section Editor)

Huntington Disease: Linking Pathogenesis to the Development of Experimental Therapeutics

Leitlinien kompakt für die Neurologie

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Kostenlos registrieren

Neu im Fachgebiet Neurologie

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Frühe Alzheimertherapie lohnt sich

25.04.2024 AAN-Jahrestagung 2024 Nachrichten

Ist die Tau-Last noch gering, scheint der Vorteil von Lecanemab besonders groß zu sein. Und beginnen Erkrankte verzögert mit der Behandlung, erreichen sie nicht mehr die kognitive Leistung wie bei einem früheren Start. Darauf deuten neue Analysen der Phase-3-Studie Clarity AD.

Viel Bewegung in der Parkinsonforschung

25.04.2024 Parkinson-Krankheit Nachrichten

Neue arznei- und zellbasierte Ansätze, Frühdiagnose mit Bewegungssensoren, Rückenmarkstimulation gegen Gehblockaden – in der Parkinsonforschung tut sich einiges. Auf dem Deutschen Parkinsonkongress ging es auch viel um technische Innovationen.

Demenzkranke durch Antipsychotika vielfach gefährdet

23.04.2024 Demenz Nachrichten

Wenn Demenzkranke aufgrund von Symptomen wie Agitation oder Aggressivität mit Antipsychotika behandelt werden, sind damit offenbar noch mehr Risiken verbunden als bislang angenommen.

Update Neurologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen
Bildnachweise